Provider Demographics
NPI:1164115820
Name:DEFIORE, CRISTINA M
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:M
Last Name:DEFIORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:M
Other - Last Name:WIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:42217 ANN ARBOR RD E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4364
Mailing Address - Country:US
Mailing Address - Phone:734-737-1455
Mailing Address - Fax:
Practice Address - Street 1:42217 ANN ARBOR RD E
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4364
Practice Address - Country:US
Practice Address - Phone:734-737-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851109915104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty